Many different types of medical devices are implanted within patients to provide medical therapy. One type of implanted medical device is a cardiac rhythm management device, such as a pacemaker or implantable defibrillator. Cardiac rhythm management (CRM) devices are used to provide medical therapy to patients who have a disorder related to cardiac rhythm, such as bradycardia or tachycardia.
Magnetic resonance imaging (MRI) is a method of visualizing body tissues of a patient, primarily to identify pathological conditions or to visualize physiological structure for purposes of medical diagnosis and therapy. MRI relies on subjecting the body tissue of interest to a very strong uniform magnetic field, up to about 30,000 gauss, as well as a moderate strength but variable magnetic field of around 200 gauss. In the presence of these uniform and gradient magnetic fields, a radio frequency (RF) pulse is transmitted from a coil to the body tissue. Hydrogen atoms within the body tissue have a magnetic moment and tend to line up with the direction of the applied magnetic fields. Some of these hydrogen atoms will align facing one direction and others will align facing an opposite direction, such that most of the hydrogen atoms facing in alternating directions will tend to cancel each other out. However, a small percentage (but a significant absolute number) of hydrogen atoms will be unbalanced, or not cancelled out. The applied RF pulse tends to cause the unbalanced hydrogen protons to spin, or resonate, in a particular direction and at a particular frequency. When this RF pulse is turned off, the spinning hydrogen protons revert to their earlier, aligned position, and release their excess energy. The RF coil of the MRI machine is capable of detecting this emitted energy and transmitting a corresponding signal to a processor that transforms the signal to an image of the body tissue. Because different tissues have different characteristic responses to the application of the RF pulse in the presence of the magnetic fields, these differences can be utilized to prepare an image showing areas of contrasting tissue types.
MRI techniques have proven to be very effective at diagnosing certain medical conditions and allowing for patients to receive timely, appropriate medical therapy. However, in many cases patients having an implanted medical device are contraindicated for MRI, and therefore may be unable to benefit from the full scope of medical treatments available to them. One problem is that the MRI's RF field can induce a high frequency current within the implanted device, and this high frequency current can result in tissue heating. In certain circumstances the tissue heating can cause serious injury to the patient. Another and potentially very serious problem for a patient having certain implanted medical devices, particularly a cardiac rhythm management device, is the potential for the MRI machine to create a low frequency induced current (LFIC) in the implanted device. LFIC arises from the interaction between the MRI system's time-varying magnetic gradient fields and any conductive loop associated with the implanted device. LFIC in a CRM device can actually cause pacing of the heart by activating nerve or muscle cells within the heart. In this way, it is possible for the MRI machine to inadvertently pace the patient's heart. The LFIC can also distort the wave shape of intended pacing pulses, possibly resulting in a diminished effectiveness of the pacing pulse.
Importantly, LFIC can also interfere with the pacemaker system's ability to properly sense cardiac activity, possibly resulting in inhibited pacing or pacing that is too rapid. Pacing that is inhibited or too rapid can cause injury or discomfort to a patient. Some CRM devices are configured to be manually set to an asynchronous mode during an MRI procedure, where the CRM device is configured to deliver pacing at a constant rate regardless of sensed heart rate. In essence, the sensing capabilities of the CRM device are turned off while in the MRI machine. While this technique addresses the MRI-induced interference with the sensed signals, it does not provide optimal pacing to the patient. For example, a patient who experiences fibrillation while undergoing an MRI procedure will not receive the therapy that an implanted device may be configured to deliver.
Improved techniques for using an implantable medical device for sensing a patient's heart rate are needed.